Exploration Station® Membership Application
Please choose your membership package.  Please print legibly. 


_____    Resident Basic Membership – (Up to 2 people)                             $27.00

_____    Non-Resident Basic Membership – (Up to 2 people)                    $45.00

_____    Resident Family I Membership – (Up to 4 people)                        $45.00

_____    Non-Resident Family I Membership – (Up to 4 people)                $60.00

_____    Resident Family II Membership – (Up to 6 people)                       $55.00

_____    Non-Resident Family II Membership – (Up to 6 people)               $80.00

_____    Supporter Membership                                                                 $105.00

_____    Supersize Members                  Qty:_________X $10.00 =          $_______

_____    Discount/coupon                                                                           $_______    

                                                                                TOTAL FEES           $____________

Cash____     Check #_______           

 Credit card # ____________________________  Exp.__________ 

Signature:______________________________________

Name of Member Adults:                    Date:___________________


Adult #1:___________________________     Adult #2:___________________________

Street Address:___________________________________________________________

City:_________________________________  State:_________  Zip:___________

Daytime Phone #:______________________ Evening Phone#:______________________

E-mail address:________________________________________


Children or Grandchildren: (Names and dates of birth must be listed in order to receive benefits.)

Child #1:_____________________________________________   DOB:_____________

Child #2:_____________________________________________   DOB:_____________

Child #3:_____________________________________________   DOB:_____________

Child #4:_____________________________________________   DOB:_____________

Child #5:_____________________________________________   DOB:_____________

Supersize Members:

Adult____or Child_____Name:____________________________  DOB_____________ 

Adult____or Child_____Name:____________________________  DOB_____________     

REFERRED BY:___________________________________________________
Explroation Station Logo

 

 

 

 

 

 

 

 

 

 

 

 


This membership is a gift from:

Name: _____________________________

Address:____________________________

City:_______________________________

State:_____________ Zip:______________

Please mail membership certificate to:

Giver:__________ Recipient:____________

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Please return this form to:

Exploration Station®...a children’s museum, 495 N. Kennedy Dr., Bourbonnais, IL 60914

Cash, Check, Visa or MasterCard are accepted payments. Please make checks payable to:  BTPD